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Dr. Greenberg:
The prevalence of social media has grown significantly over the past few decades, and within the field of medicine, we've seen a rise in dermatologists using these platforms to grow their professional network, improve patient care, and provide patient education.  But can widespread social media presence present ethical challenges as well? 

Welcome to DermConsult on ReachMD.  I'm Dr. Michael Greenberg.  And joining me today to discuss his own social media presence is Dr. Dustin Portela.  He's a dermatologist and Mohs surgeon at Treasure Valley Dermatology & Skin Cancer Center in Boise, Idaho.  And more importantly, he's known as 208skindoc—that's D-O-C—on social media. 

Dustin, welcome to the program. 

Dr. Portela:
Thank you, Michael.  I'm pleased to be here, a long-time listener as they say. 

Dr. Greenberg:
Well, thanks.  So let's start, Dustin.  Tell us a little bit about your online presence.  And how did you get started on social media? 

Dr. Portela:
You know, my desire to get started on social media really began when I opened my own private practice in dermatology here in Boise, Idaho.  And there's many ways that an individual or a practice can market themselves, and I had started to read some books and other information on how to market without spending a lot of money.  And social media is free, and so I started posting on social media, and then this TikTok platform kind of came along, and I started posting on there, and that really became a quick way to grow a social media following.  And that spills over into many of the other platforms, and that helps bring patients through the door.  And so it really started with my desire just to try to get some marketing done for my own clinic and do that in an inexpensive way as a new startup. 

Dr. Greenberg:
That's great.  So, from your vantage point as a dermatologist, how has this type of online access impacted the way you provide care? 

Dr. Portela:
Initially, there was not a lot that changed, but once I started having patients come in because they were following me on social media, it does make you think a little bit about what their perception is of you.  And if people are coming in because they saw you on social, are there people that are choosing not to come in because they saw you on social? Because I don't think you can keep everybody happy, so there may be some that find it unprofessional, and they'll search other doctors, and I'm okay with that. I don't pretend that I'm going to please everybody.  I don't think anybody should try.  And then also, as patients come in, they may want to be featured on social media, and so that could be sometimes another conversation.  But ultimately, what it has come down to is that with each patient, whether they came in because of social or they want to be on social, I tell them that my number one priority is to treat them like any other patient, that we want to get whatever their issue is resolved as quickly as possible.  And I never have approached a patient encounter thinking this has to get on social.   It's always first let me get this patient taken care of, and then secondarily, if they're okay with doing something together on social, then we'll approach that, but we always outline the treatment plan and everything first. 

Dr. Greenberg:
So as we know, social media is often used as a platform to debunk misinformation.   Have you done this online?  And can you share why this is so important to you? 

Dr. Portela:
Absolutely.  I think over the last couple years in particular we've all seen many examples, both in healthcare, in politics, in really so many different fields where misinformation spreads so quickly, and it can be challenging to try to get a handle on that, to correct or to improve the narrative, and I saw so many instances of really bad skin advice going viral on TikTok.  And the way that TikTok is programmed, you can get on and make reaction videos—or it's called a “duet”— quite easily to try to correct misinformation, and the algorithm will often piggyback your video on the original video.  And I found that people responded well by getting an expert opinion to something they had heard that I really found to be a problem, from do-it-yourself skincare to removing moles at home, which we all know is a bad idea.  So it's been one of the first things I started doing on social, and it continues to be an integral part of my social media content strategy. 

Dr. Greenberg:
So beyond debunking information, social media also allows you to connect to other dermatologists around the globe.  So Dustin, has your social media presence led to networking with new colleagues?  Have you met really fascinating dermatologists out there like yourself? 

Dr. Portela:
That has been one of my favorite things to do because of social media is to start to network and connect with other colleagues.  There are some other dermatologists that are on social media before or after me that I have now made friends with.  And then as the world has started to open up a little bit, we're now going to conferences and getting to meet face-to-face and become friends. —Everybody knows Dr. Pimple Popper, Dr. Sandra Lee.  She's fantastic.   And then lots of plans coming up for the American Academy of Dermatology meeting.  So many great dermatologists I've been able to learn from and even outside the field of dermatology, you know, estheticians and others who have very valuable things to contribute to the skincare discussion.  So it's been a great way to make new friends and to network. 

Dr. Greenberg:
For those of you just tuning in, you're listening to DermConsult on ReachMD.  I'm Dr. Michael Greenberg, and today I'm speaking with Dr. Dustin Portela on social media use in dermatology, and it's a fascinating conversation. 

So Dustin, let's turn our attention to the ethical considerations of social media, such as the risk of a conflict of interest.  Have you faced any ethical dilemmas when it comes to privacy or professional boundaries?  And how have you overcome these obstacles? 

Dr. Portela:
Well certainly the privacy of patients comes first, and only when I have a very enthusiastic patient will we put them on social media.  And I consulted with an attorney and drafted a completely separate kind of consent form that really outlines how this content may be used, and there's been times where we've recorded and then chosen not to use it, and so privacy is certainly one of those ethical concerns because we don't want to show a patient in a way that could compromise their identity or a diagnosis that they're not comfortable with.  So we're very careful about the conversations with patients that may want to be on social media about how they're okay with their image being used or do we need to zoom in and only show the procedure, for example, so that's one.  And of course there are other conflict of interest-type concerns.  You know, I've been recommending certain skincare brands for, years, since day one of residency, and I've been fortunate enough to be able to work with many skincare brands after growing a large following, and I think anytime there is a financial relationship to talk about a brand, it's a perceived conflict of interest, and it's something you have to be very careful with, so I do like to let followers know that when it comes to some of these brand deals and things, that I turn down lots of them if it's not a product that I would use or recommend in my clinic. And I think those are things that come most to people's minds is patient privacy and conflict of interest with relationship to industry. 

Dr. Greenberg:
Do you expose your conflicts of interest to people on your TikToks? 

Dr. Portela:
Yeah, so anytime you're doing a paid advertisement, there's regulations from the FCC, so it has to be disclosed that it's a paid advertisement, and there are certain ways to be compliant about that or not, and I've never hesitated away from answering specifically when they're asking, "Is this an ad?"  Well, yes, this is an advertisement.   And then working on a new website where I want to have a place where patients can find all the information that I'd like to provide but also listing all conflicts and disclosures on a separate webpage, even if I worked with a company two years ago, for example, so that is an important thing to me to let patients know that these potential conflicts can exist. 

Dr. Greenberg:
What factors do you take into consideration when maintaining a professional online presence? 

Dr. Portela:
When I went through medical school, there was so much time where it was just head down, nose to the grindstone, get through medical school, get through internship, get through residency, that I felt like maybe I had lost a little bit of my personality because I was so focused for so long, and social media in some ways has given me the chance to kind of open back up and show off the goofy side that I have..  And I do feel that it's very important to continue to be professional, but I also want to be myself.  And I am a little bit goofy, and I don't think that that's wrong to show patients, and I think it helps to develop trust with the patients that choose me as their physician because they know that I'm a real person and not just putting up some very polished, always perfect photograph or video.  And sometimes I've chimed in on topics that maybe I wasn't as informed about, and then I'll do follow-up videos and say, "Hey, you know,  maybe I didn't know enough about this, and here is what I've done to learn about that."  So I feel that professionalism is obviously important, but I also want people to know that I'm a real person and that I have a personality, so it's a balance. 

Dr. Greenberg:
After listening to you, I would say that you are full of fun and humor and I think that would attract patients. 

Dr. Greenberg:
So, Dustin, what kind of impact do you think your online presence has had on patient education and care? Because that's really important.

Dr. Portela:
It really is, and the things that touch me the most are the patients that will send me private messages about how their life has changed in a meaningful way.  And the most impactful are, of course, "I went and got a skin check because of you, and my doctor found a skin cancer, and thankfully, we caught it early.  I wouldn't have gone if I hadn't known about these risks because you talked about them."   And it's certainly rewarding to hear patients who improve their acne or their complexion, their self-confidence, but when I get those messages where a patient's life has potentially been saved because somebody found a melanoma on them, that's what really makes me keep coming back to the platform and providing the education. 

Dr. Greenberg:
So, lastly, Dustin, what would you share to other dermatologists about being on social media? 

Dr. Portela:
Social media can be daunting, it can be scary at times, and it may seem insurmountable because there are now a lot of dermatologists on social media, but I would encourage anybody who has a curiosity about being on there, whether it's to educate, whether it's to grow your own practice, to just go ahead and start posting.  Don't worry about your content being perfect or polished.  But there is a conversation happening on social media about skincare, about health in general, and oftentimes those voices are misinformed, and if you don't go to where the conversation is, patients can be left in the dark, and you're going to miss out on opportunities to grow your practice or to change somebody's life. So go to where the conversation is happening, and just don't worry about having everything perfect. 

Dr. Greenberg:
Yeah, it sounds like the motto should be "keep it real and keep it honest." 

Dr. Portela:
I agree. 

Dr. Greenberg:
With those considerations in mind, I want to thank my guest, Dr. Dustin Portela, for giving us an inside look at this online presence and sharing his insights on social media and dermatology.  Dustin, it was great speaking with you today. 

Dr. Portela:
It was my pleasure.  Thank you so much. 

Dr. Greenberg:
For ReachMD, I'm Dr. Michael Greenberg.  To access this episode and others from the series, visit ReachMD.com/DermConsult, where you can Be Part of the Knowledge.  And thank you for listening.